Provider Demographics
NPI:1730509035
Name:VICTORY HOMECARE LLC
Entity type:Organization
Organization Name:VICTORY HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-474-2758
Mailing Address - Street 1:6751 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:OH
Mailing Address - Zip Code:44086-9798
Mailing Address - Country:US
Mailing Address - Phone:440-474-2758
Mailing Address - Fax:
Practice Address - Street 1:6751 MADISON RD
Practice Address - Street 2:
Practice Address - City:THOMPSON
Practice Address - State:OH
Practice Address - Zip Code:44086-9798
Practice Address - Country:US
Practice Address - Phone:440-474-2758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care